Letters to the Editor

Dr. Thomas Ricketts: Enough doctors for Medicaid expansion

In his Dec. 27 Point of View piece “ Why Medicaid expansion won’t boost jobs,” Brian Balfour observed that there would not be enough physicians to care for the people who would gain coverage were North Carolina to expand Medicaid. He stated that the ratio of primary care physicians in the state had recently fallen and that North Carolina was below the national average.

In fact, over the past decade, North Carolina’s physician supply has grown at a rate almost twice as fast as the population, and primary care physician growth has matched that rate. North Carolina had 21,788 licensed practicing physicians in 2012, up from 16,789 in 2002 – a 30 percent increase. In comparison, the state’s population grew by 17 percent over the same decade.

The total number of actively practicing physicians per 10,000 persons in North Carolina consistently grew from 19.78 in 2000 to 22.31 in 2012. The number of primary care physicians has historically grown at roughly the same rate. However, in 2010, the North Carolina Medical Board modified the way it classified physicians, shifting to “area of practice” and away from specialty of training. In North Carolina, primary care physicians are defined as those who practice in the specialties of family medicine, general internal medicine, general pediatrics, obstetrics/gynecology and general practice. In the 2010-11 licensing renewal process, physicians were able to indicate their primary area of practice. This included designations such as “integrative medicine” and “urgent care” that would have been counted as primary care in the earlier system.

By applying the combination of specialty training as well as area of practice to count primary care doctors, the number would have grown from 9,017 in 2010 to roughly 10,100 in 2012, or from 9.4 per 10,000 to 10.4 per 10,000, a 10 percent rate of growth over two years.

Balfour also cited 78 counties as (Primary Care) Health Professional Shortage Areas. In fact, the federal designations in 2012 applied to 16 whole counties, with parts of 62 other counties also meeting shortage criteria. These designations remain even if the need for primary care services has been met by physicians placed as part of the National Heath Service Corps or via a loan repayment program. In August, North Carolina needed 184 primary care physicians to match the needs in the designated areas. The state has placed between 60 and 100 physicians into underserved areas each year, so the absolute shortage at any given time is perhaps 100 to 120 full-time equivalent primary care physicians.

There are other primary care practitioners who would care for newly insured Medicaid patients. Between 2002 and 2012, the state’s nurse practitioner workforce grew by 113 percent and physician assistants by 83 percent.

There are communities in North Carolina that need primary care physicians, nurse practitioners and physician assistants, but the numbers are not so great as to imperil the ability of the state to care for people with newly gained Medicaid coverage.

Thomas C. Ricketts, Ph.D.

Deputy director, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill

Chapel Hill

The length limit was waived to permit a fuller response to the Point of View.